Palliative care improves outcomes for seniors

Fewer emergency room visits, less depression

Seniors in long-term care experienced a significant reduction in emergency room visits and depression when receiving palliative care services, according to a recent collaborative study by researchers at Hebrew SeniorLife's Hebrew Rehabilitation Center (HRC) and Institute for Aging Research, both affiliated with Harvard Medical School (HMS).

The results of the study, published today in The Gerontologist, demonstrate the potential for improved end-of-life quality of care when palliative services are implemented in a long-term care setting.

The researchers analyzed the composite outcomes of utilization patterns, depression, pain and other clinical indicators of 250 long-term care patients at Hebrew Rehabilitation Center, half of whom received palliative care services, over a two-year period. Those who received palliative care had about half as many emergency room visits and significantly less depression.

"The national health care crisis has created a mandate to cut costs while improving care for millions of aging Americans who would otherwise experience frequent hospitalizations and futile aggressive care in their last months," says Jody Comart, Ph.D., palliative care director at Hebrew SeniorLife and the study's lead author.

"Many patients and families fear a painful, undignified death. The palliative care team is an elegant model that can improve care for long-term care residents and, at the same time bring down costs. This study showed a decrease in emergency room visits for palliative care patients, avoiding an often frightening event for patients and families, while decreasing the high cost of this expensive service for our health care system.

The Palliative Care Program at HRC combines medical, emotional and spiritual support services provided by an interdisciplinary team — a palliative care physician, clinical nurse specialist, chaplain, social worker and psychologist — providing the expertise and structure for improved symptom management and earlier identification of residents' goals for care.

According to Comart, providing palliative care services in a long-term care setting can offer significant benefits to patients and their loved ones:

- Patients and families often face very intense, emotionally laden and ethically burdensome decisions about treatment options.
- Palliative care provides them with medical and technical information that fosters informed conversations about end-of-life care — often for the first time.
- By treating pain and other symptoms, decreasing unnecessary hospitalizations and helping patients find closure during their final days, palliative care can reduce patient suffering and ease the burden on families.

"Some patients prefer less aggressive treatment and improved quality of life, while others want intensive interventions that may involve hospitalization and procedures," Comart explains. "Whatever the choice, patient-centered care is the primary goal, focusing on treatment that is consistent with the resident's wishes or, in the case of patients who are unable to comprehend the decisions at hand, with prior stated wishes."